Journal of Abnormal Child Psychology

, Volume 44, Issue 2, pp 347–355 | Cite as

Recalled Initiation and Duration of Maternal Breastfeeding Among Children with and Without ADHD in a Well Characterized Case–Control Sample

  • Diane D. Stadler
  • Erica D. Musser
  • Kathleen F. Holton
  • Jackilen Shannon
  • Joel T. NiggEmail author


Early environmental influences are increasingly of interest in understanding ADHD as a neurodevelopmental condition, particularly in light of recognition that gene by environment interplay are likely involved in this condition. Breastfeeding duration predicts cognitive development, as well as development of brain white matter connectivity, in areas similar to those seen in ADHD. Prior studies show an association between breastfeeding and ADHD but without adequate evaluation of ADHD. A case control cohort of 474 children aged 7–13 years was examined, 291 with wellcharacterized ADHD (71.5 % male) and the rest typically developing controls (51.9 % male). Mothers retrospectively reported on breast feeding initiation and duration. Initiation of breastfeeding was not associated with child ADHD, but shorter duration of breastfeeding was associated with child ADHD with a medium effect size (d = 0.40, p < 0.05); this effect held after covarying a broad set of potential confounders, including child oppositional defiant and conduct problems and including maternal and paternal ADHD symptoms. Effects were replicated across both parent and teacher ratings of child ADHD symptoms. Shorter duration of breastfeeding is among several risk factors in early life associated with future ADHD, or else longer duration is protective. The direction of this effect is unknown, however. It may be that some children are more difficult to breastfeed or that breastfeeding provides nutrients or other benefits that reduce future chance of ADHD.


Environmental influences Neurodevelopmental condition Breastfeeding Maternal ADHD ADHD Child ADHD ADHD and depression Child ADHD symptoms Breastfeeding ADHD Case–control study 



DDS, KH, JS, JTN designed the research; EDM conducted research; EDM, JTN analyzed data; DDS, EDM, JTN wrote the paper and had primary responsibility for the final content. All authors read and approved the final manuscript.

Conflict of Interest

The authors report no conflicts of interest. This work was supported by NIMH MH59105 (Nigg) and by the Bob and Charlee Moore Institute for Nutrition & Wellness at Oregon Health & Science University.


  1. Al Hamed, J. H., Taha, A. Z., Sabra, A. A., & Bella, H. (2008). Attention deficit hyperactivity disorder (ADHD) among male primary school children in Dammam, Saudi Arabia: prevalence and associated factors. Journal Egypt Public Health Association, 83, 165–182.Google Scholar
  2. Allen, N. B., Lewinsohn, P. M., & Seeley, J. R. (1998). Prenatal and perinatal influences on risk for psychopathology in childhood and adolescence. Journal Development and Psychopathology, 10, 513–529.CrossRefPubMedGoogle Scholar
  3. American Academy of Family Physicians. (2007). Breastfeeding, family physicians supporting (Position paper). Retrieved July, 20, 2014, from
  4. American College of Obstetricians Gynecologists. (2007). Committee opinion no. 361: breastfeeding: maternal and infant aspects. Obstetrics & Gynecology Journal, 109, 479–480.CrossRefGoogle Scholar
  5. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Washington, DC: Author.Google Scholar
  6. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. 5th Edition. Washington, DC; Author.Google Scholar
  7. American Psychology Association. (2002). Ethical principles of psychologists and code of conduct. American Psychology Association, 57, 1060–1073.CrossRefGoogle Scholar
  8. American Public Health Association. (2007). Policy statement database: A call to action on breastfeeding: A fundamental public health issue. Policy number 200714. Policy Date: November 6, 2007 Retrieved July 20, 2014, from
  9. Anderson, J. W., Johnstone, B. M., & Remley, D. T. (1999). Breast-feeding and cognitive development: a meta-analysis. American Journal of Clinical Nutrition, 70, 525–535.PubMedGoogle Scholar
  10. Angelsen, N. K., Vik, T., Jacobsen, G., & Bakketeig, L. S. (2001). Breast feeding and cognitive development at age 1 and 5 years. Archives of Disease in Childhood, 85, 183–188.PubMedCentralCrossRefPubMedGoogle Scholar
  11. Astbury, J., Orgill, A., & Bajuk, B. (1987). Relationship between 2-year behaviour and neurodevelopmental outcome at 5 years of very low-birthweight survivors. Developmental Medicine and Child Neurology, 29, 370–379.CrossRefPubMedGoogle Scholar
  12. Ballard, O., & Morrow, A. L. (2013). Human milk composition: nutrients and bioactive factors. Pediatric Clinics of North America, 60, 49–74. doi: 10.1016/j.pcl.2012.10.002.PubMedCentralCrossRefPubMedGoogle Scholar
  13. Ben Amor, L., Grizenko, N., Schwartz, G., Lageix, P., Baron, C., Ter-Stepanian, M., Zappitelli, M., Mbekou, V., & Joober, R. (2005). Perinatal complications in children with attention-deficit hyperactivity disorder and their unaffected siblings. Journal of Psychiatry & Neuroscience, 30, 120–126.Google Scholar
  14. Center for Disease Control. (2013). Breastfeeding report card. Last updated : July 31, 2013. Retrieved July, 20, 2014, from
  15. Conners, K. C. (2008). Multi-Health Systems, Inc. New York.Google Scholar
  16. Cupul-Uicab, L. A., Gladen, B. C., Hernandez-Avila, M., & Longnecker, M. P. (2009). Reliability of reported breastfeeding duration among reproductive-aged women from Mexico. Maternal & Child Nutrition, 5, 125–137.CrossRefGoogle Scholar
  17. D’Onofrio, B. M., Van Hulle, C. A., Waldman, I. D., Rodgers, J. L., Harden, K. P., Rathouz, P. J., & Lahey, B. B. (2008). Smoking during pregnancy and offspring externalizing problems: an exploration of genetic and environmental confounds. Development and Psychopathology, 20, 139–164. doi: 10.1017/S0954579408000072.PubMedCentralPubMedGoogle Scholar
  18. DuPaul, G. J., Power, T. J., Anastopoulos, A. D., & Reid, R. (1998). ADHD rating scale-IV: Checklists, norms, and clinical interpretation. New York: Guilford Press.Google Scholar
  19. Field, S. S. (2014). Interaction of genes and nutritional factors in the etiology of autism and attention deficit/hyperactivity disorders: a case control study. Journal of Medical Hypotheses, 82, 654–661.CrossRefPubMedGoogle Scholar
  20. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV-TR axis I disorders (Vol. Research Version, (SCID-I/NP) Biometrics Research). New York: New York State Psychiatric Institute.Google Scholar
  21. Forsyth, J. S., Willatts, P., Agostoni, C., Bissenden, J., Casaer, P., & Boehm, G. (2003). Long chain polyunsaturated fatty acid supplementation in infant formula and blood pressure in later childhood: follow up of a randomised controlled trial. British Medical Journal, 326, 953. doi: 10.1136/bmj.326.7396.953.PubMedCentralCrossRefPubMedGoogle Scholar
  22. Gartner, L. M., Morton, J., Lawrence, R. A., Naylor, A. J., O’Hare, D., Schanler, R. J., & Eidelman, A. I. (2005). Breastfeeding and the use of human milk. Pediatrics, 115, 496–506.CrossRefPubMedGoogle Scholar
  23. Golmirzaei, J., Namazi, S., Amiri, S., Zare, S., Rastikerdar, N., Hesam, A. A., Rahami, Z., Ghasemian, F., Namazi, S. S., Paknahad, A., Mahmudi, F., Mahboobi, H., Khorgoei, T., Niknejad, B., Dehghani, F., & Asadi, S. (2013). Evaluation of attention-deficit hyperactivity disorder risk factors. International Journal of Clinical Pediatrics, 953103, 953103.Google Scholar
  24. Hayes, A.F. & Scharkow, M. (2013). The relative trustworthiness of inferential tests of the indirect effect in statistical mediation analysis: does method really matter? Psychological Science, 24, 1918-1927.Google Scholar
  25. Herba, C. M., Roza, S., Govaert, P., Hofman, A., Jaddoe, V., Verhulst, F. C., & Tiemeier, H. (2013). Breastfeeding and early brain development: the generation R study. Maternal & Child Nutrition, 9, 332–349. doi: 10.1111/mcn.12015.CrossRefGoogle Scholar
  26. Huang, J., Peters, K. E., Vaughn, M. G., & Witko, C. (2014). Breastfeeding and trajectories of children’s cognitive development. Journal Developmental Science, 17, 452–461. doi: 10.1111/desc.12136.CrossRefPubMedGoogle Scholar
  27. Julvez, J., Ribas-Fito, N., Forns, M., Garcia-Esteban, R., Torrent, M., & Sunyer, J. (2007). Attention behaviour and hyperactivity at age 4 and duration of breast-feeding. Acta Paediatrica, 96, 842–847. doi: 10.1111/j.1651-2227.2007.00273.x.CrossRefPubMedGoogle Scholar
  28. Kadziela-Olech, H., & Piotrowska-Jastrzebska, J. (2005). The duration of breastfeeding and attention deficit hyperactivity disorder. Rocz Akad Med Bialymst Journal, 50, 302–306.Google Scholar
  29. Kaplan, L. A., Evans, L., & Monk, C. (2008). Effects of mothers’ prenatal psychiatric status and postnatal caregiving on infant biobehavioral regulation: can prenatal programming be modified? Early Human Development, 84, 249–256.PubMedCentralCrossRefPubMedGoogle Scholar
  30. Karalunas, S. L., Fair, D., Musser, E. D., Aykes, K., Iyer, S. P., & Nigg, J. T. (2014). Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria. JAMA Psychiatry, 9, 763.Google Scholar
  31. Koletzko, B., Lien, E., Agostoni, C., Bohles, H., Campoy, C., Cetin, I., Decsi, T., Dudenhausen, J. W., Dupont, C., Forsyth, S., Hoesli, I., Holzgreve, W., Lapillonne, A., Putet, G., Secher, N. J., Symonds, M., Szajewska, H., Willatts, P., Uauy, R., & World Association of Perinatal Medicine Dietary Guidelines Working, G. (2008). The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations. Journal of Perinatal Medicine, 36, 5–14. doi: 10.1515/JPM.2008.001.PubMedGoogle Scholar
  32. Kotimaa, A. J., Moilanen, I., Taanila, A., Ebeling, H., Smalley, S. L., McGough, J. J., Hartikainen, A. L., & Jarvelin, M. R. (2003). Maternal smoking and hyperactivity in 8-year-old children. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 826–833.CrossRefPubMedGoogle Scholar
  33. Li, R., Scanlon, K. S., & Serdula, M. K. (2005). The validity and reliability of maternal recall of breastfeeding practice. Nutrition Reviews, 63, 103–110.CrossRefPubMedGoogle Scholar
  34. McGrath, M. M., Sullivan, M. C., Lester, B. M., & Oh, W. (2000). Longitudinal neurologic follow-up in neonatal intensive care unit survivors with various neonatal morbidities. Pediatrics, 106, 1397–1405.CrossRefPubMedGoogle Scholar
  35. Mick, E., Biederman, J., Faraone, S. V., Sayer, J., & Kleinman, S. (2002). Case–control study of attention-deficit hyperactivity disorder and maternal smoking, alcohol use, and drug use during pregnancy. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 378–385.CrossRefPubMedGoogle Scholar
  36. Milberger, S., Biederman, J., Faraone, S. V., Guite, J., & Tsuang, M. T. (1997). Pregnancy, delivery and infancy complications and attention deficit hyperactivity disorder: issues of gene-environment interaction. Biological Psychiatry, 41, 65–75.CrossRefPubMedGoogle Scholar
  37. Mimouni-Bloch, A., Kachevanskaya, A., Mimouni, F. B., Shuper, A., Raveh, E., & Linder, N. (2013). Breastfeeding may protect from developing attention-deficit/hyperactivity disorder. Breastfeed Medicine Journal, 8, 363–367.CrossRefGoogle Scholar
  38. Nagel, B. J., Bathula, D., Herting, M., Schmitt, C., Kroenke, C. D., Fair, D., & Nigg, J. T. (2011). Altered white matter microstructure in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 283–292. doi: 10.1016/j.jaac.2010.12.003.PubMedCentralCrossRefPubMedGoogle Scholar
  39. Natland, S. T., Andersen, L. F., Nilsen, T. I., Forsmo, S., & Jacobsen, G. W. (2012). Maternal recall of breastfeeding duration 20 years after delivery. BMC Medical Research Methodology, 12, 179.PubMedCentralCrossRefPubMedGoogle Scholar
  40. Nigg, J. T. (2003). Response inhibition and disruptive behaviors: toward a multi-process conception of etiological heterogeneity for ADHD combined type and conduct disorder early onset type. Annals of the New York Academy of Sciences, 1008, 170–182.CrossRefPubMedGoogle Scholar
  41. Nigg, J. T., & Breslau, N. (2007). Prenatal smoking exposure, low birth weight, and disruptive behavior disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 362–369.CrossRefPubMedGoogle Scholar
  42. Oddy, W. H., Li, J., Whitehouse, A. J., Zubrick, S. R., & Malacova, E. (2011). Breastfeeding duration and academic achievement at 10 years. Pediatrics, 127, e137–e145. doi: 10.1542/peds. 2009-3489.CrossRefPubMedGoogle Scholar
  43. Ou, X., Andres, A., Cleves, M. A., Pivik, R. T., Snow, J. H., Ding, Z., & Badger, T. M. (2014). Sex-specific association between infant diet and white matter integrity in 8-y-old children. Pediatric Research. doi: 10.1038/pr.2014.129.PubMedGoogle Scholar
  44. Preacher, K. L. & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods Instruments & Computers, 36(4), 717-731.Google Scholar
  45. Puig-Antich, J. R., & Kiddie, N. (1996). Schedule for affective disorders and schizophrenia. Pittsburgh: Western Psychiatric Institute.Google Scholar
  46. Quigley, M. A., Hockley, C., Carson, C., Kelly, Y., Renfrew, M. J., & Sacker, A. (2012). Breastfeeding is associated with improved child cognitive development: a population-based cohort study. The Journal of Pediatrics, 160, 25–32. doi: 10.1016/j.jpeds.2011.06.035.CrossRefPubMedGoogle Scholar
  47. Sabuncuoglu, O., Orengul, C., Bikmazer, A., & Kaynar, S. Y. (2014). Breastfeeding and parafunctional oral habits in children with and without attention-deficit/hyperactivity disorder. Breastfeed Medicine Journal, 9, 244–250.CrossRefGoogle Scholar
  48. Schmitt, J., & Romanos, M. (2012). Prenatal and perinatal risk factors for attention-deficit/hyperactivity disorder. Archives of Pediatrics and Adolescent Medicine, 166, 1074–1075.CrossRefPubMedGoogle Scholar
  49. Shamberger, R. (2012). Attention-deficit disorder associated with breast-feeding: a brief report. Journal of the American College of Nutrition, 31, 239–242.CrossRefPubMedGoogle Scholar
  50. Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 171, 276–293.PubMedCentralCrossRefPubMedGoogle Scholar
  51. Tawia, S. (2013). Breastfeeding, brain structure and function, cognitive development and educational attainment. Breastfeeding Review, 21, 15–20.PubMedGoogle Scholar
  52. Thapar, A., Rice, F., Hay, D., Boivin, J., Langley, K., van den Bree, M., Rutter, M., & Harold, G. (2009). Prenatal smoking might not cause attention-deficit/hyperactivity disorder: evidence from a novel design. Biological Psychiatry, 66, 722–727. doi: 10.1016/j.biopsych.2009.05.032.PubMedCentralCrossRefPubMedGoogle Scholar
  53. Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., Perou, R., & Blumberg, S. J. (2014). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. Journal of the American Academy of Child and Adolescent Psychiatry, 53(34–46), e32. doi: 10.1016/j.jaac.2013.09.001.Google Scholar
  54. Wells, J. C., Chomtho, S., & Fewtrell, M. S. (2007). Programming of body composition by early growth and nutrition. Proceedings of the Nutrition Society, 66, 423–434.CrossRefPubMedGoogle Scholar
  55. Wigg, N. R., Tong, S., McMichael, A. J., Baghurst, P. A., Vimpani, G., & Roberts, R. (1998). Does breastfeeding at 6 months predict cognitive development? Australian and New Zealand Journal of Public Health, 22, 232–236.CrossRefPubMedGoogle Scholar
  56. Willatts, P., Forsyth, S., Agostoni, C., Casaer, P., Riva, E., & Boehm, G. (2013). Effects of long-chain PUFA supplementation in infant formula on cognitive function in later childhood. American Journal of Clinical Nutrition, 98, 536s–542s. doi: 10.3945/ajcn.112.038612.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Diane D. Stadler
    • 1
  • Erica D. Musser
    • 2
  • Kathleen F. Holton
    • 3
  • Jackilen Shannon
    • 4
  • Joel T. Nigg
    • 5
    Email author
  1. 1.Graduate Programs in Human NutritionOregon Health & Science UniversityPortlandUSA
  2. 2.Department of PsychologyFlorida International UniversityMiamiUSA
  3. 3.School of Education, Teaching and HealthAmerican UniversityWashingtonUSA
  4. 4.Public Health & Preventive MedicineOregon Health & Science UniversityPortlandUSA
  5. 5.Department of PsychiatryOregon Health & Science UniversityPortlandUSA

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